Impact of primary healthcare providers' initial role security and therapeutic commitment on implementing brief interventions in managing risky alcohol consumption: a cluster randomised factorial trial

M Keurhorst, P Anderson, M Heinen, Preben Bendtsen, Begoña Baena, Krzysztof Brzózka, Joan Colom, Paolo Deluca, Colin Drummond, Eileen Kaner, Karolina Kłoda, Artur Mierzecki, Dorothy Newbury-Birch, Katarzyna Okulicz-Kozaryn, Jorge Palacio-Vieira, Kathryn Parkinson, Jillian Reynolds, Gaby Ronda, Lidia Segura, Luiza Słodownik, Fredrik Spak, Ben van Steenkiste, Paul Wallace, Amy Wolstenholme, Marcin Wojnar, Antoni Gual, M Laurant, M Wensing, M Keurhorst, P Anderson, M Heinen, Preben Bendtsen, Begoña Baena, Krzysztof Brzózka, Joan Colom, Paolo Deluca, Colin Drummond, Eileen Kaner, Karolina Kłoda, Artur Mierzecki, Dorothy Newbury-Birch, Katarzyna Okulicz-Kozaryn, Jorge Palacio-Vieira, Kathryn Parkinson, Jillian Reynolds, Gaby Ronda, Lidia Segura, Luiza Słodownik, Fredrik Spak, Ben van Steenkiste, Paul Wallace, Amy Wolstenholme, Marcin Wojnar, Antoni Gual, M Laurant, M Wensing

Abstract

Background: Brief interventions in primary healthcare are cost-effective in reducing drinking problems but poorly implemented in routine practice. Although evidence about implementing brief interventions is growing, knowledge is limited with regard to impact of initial role security and therapeutic commitment on brief intervention implementation.

Methods: In a cluster randomised factorial trial, 120 primary healthcare units (PHCUs) were randomised to eight groups: care as usual, training and support, financial reimbursement, and the opportunity to refer patients to an internet-based brief intervention (e-BI); paired combinations of these three strategies, and all three strategies combined. To explore the impact of initial role security and therapeutic commitment on implementing brief interventions, we performed multilevel linear regression analyses adapted to the factorial design.

Results: Data from 746 providers from 120 PHCUs were included in the analyses. Baseline role security and therapeutic commitment were found not to influence implementation of brief interventions. Furthermore, there were no significant interactions between these characteristics and allocated implementation groups.

Conclusions: The extent to which providers changed their brief intervention delivery following experience of different implementation strategies was not determined by their initial attitudes towards alcohol problems. In future research, more attention is needed to unravel the causal relation between practitioners' attitudes, their actual behaviour and care improvement strategies to enhance implementation science.

Trial registration: ClinicalTrials.gov: NCT01501552.

Keywords: Brief interventions; Implementation research; Primary healthcare; Provider influences; Risky drinking.

Figures

Fig. 1
Fig. 1
Trial flow chart

References

    1. World Health Organization . Global status report on alcohol and health 2014. Geneva: World Health Organization; 2014.
    1. Rehm J, Mathers C, Popova S, Thavorncharoensap M, Teerawattananon Y, Patra J. Global burden of disease and injury and economic cost attributable to alcohol use and alcohol-use disorders. Lancet. 2009;373:2223–2233. doi: 10.1016/S0140-6736(09)60746-7.
    1. Lim SS, Vos T, Flaxman AD, Danaei G, Shibuya K, Adair-Rohani H, Amann M, Anderson HR, Andrews KG, Aryee M, et al. A comparative risk assessment of burden of disease and injury attributable to 67 risk factors and risk factor clusters in 21 regions, 1990–2010: a systematic analysis for the Global Burden of Disease Study 2010. Lancet. 2012;380:2224–2260. doi: 10.1016/S0140-6736(12)61766-8.
    1. Kaner EF, Beyer F, Dickinson HO, Pienaar E, Campbell F, Schlesinger C, Heather N, Saunders J, Burnand B. Effectiveness of brief alcohol interventions in primary care populations. Cochrane Database Syst Rev. 2007;2:CD004148.
    1. Anderson P. Overview of interventions to enhance primary-care provider management of patients with substance-use disorders. Drug Alcohol Rev. 2009;28:567–574. doi: 10.1111/j.1465-3362.2009.00113.x.
    1. Aalto M, Pekuri P, Seppa K. Primary health care professionals’ activity in intervening in patients’ alcohol drinking: a patient perspective. Drug Alcohol Depend. 2002;66:39–43. doi: 10.1016/S0376-8716(01)00179-X.
    1. Beich A, Gannik D, Malterud K. Screening and brief intervention for excessive alcohol use: qualitative interview study of the experiences of general practitioners. BMJ. 2002;325:870. doi: 10.1136/bmj.325.7369.870.
    1. Roche AM, Freeman T. Brief interventions: good in theory but weak in practice. Drug Alcohol Rev. 2004;23:11–18. doi: 10.1080/09595230410001645510.
    1. Drummond C, Wolstenholme A, Deluca P, Davey Z, Donoghue K, Elzerbi C, Gual A, Robles N, Goos C, Strizek J, et al. Alcohol interventions and treatment in Europe. In: Anderson P, Braddick F, Reynolds J, Gual A, et al., editors. Alcohol Policy in Europe: Evidence from AMPHORA 2nd ed The AMPHORA project. 2013.
    1. Anderson P, Wojnar M, Jakubczyk A, Gual A, Reynolds J, Segura L, Sovinova H, Csemy L, Kaner E, Newbury-Birch D, et al. Managing alcohol problems in general practice in Europe: results from the European ODHIN survey of general practitioners. Alcohol Alcohol. 2014;49:531–539. doi: 10.1093/alcalc/agu043.
    1. Anderson P, Clement S. The AAPPQ revisited: the measurement of general practitioners’ attitudes to alcohol problems. Br J Addict. 1987;82:753–759. doi: 10.1111/j.1360-0443.1987.tb01542.x.
    1. Anderson P, Kaner E, Wutzke S, Funk M, Heather N, Wensing M, Grol R, Gual A, Pas L. Attitudes and managing alcohol problems in general practice: an interaction analysis based on findings from a WHO collaborative study. Alcohol Alcohol. 2004;39:351–356. doi: 10.1093/alcalc/agh072.
    1. McCormick KA, Cochran NE, Back AL, Merrill JO, Williams EC, Bradley KA. How primary care providers talk to patients about alcohol: a qualitative study. J Gen Intern Med. 2006;21:966–972. doi: 10.1007/BF02743146.
    1. van Beurden I, Anderson P, Akkermans RP, Grol RP, Wensing M, Laurant MG. Involvement of general practitioners in managing alcohol problems: a randomized controlled trial of a tailored improvement programme. Addiction. 2012;107:1601–1611. doi: 10.1111/j.1360-0443.2012.03868.x.
    1. Funk M, Wutzke S, Kaner E, Anderson P, Pas L, McCormick R, Gual A, Barfod S, Saunders J, WHOBIS Group A multicountry controlled trial of strategies to promote dissemination and implementation of brief alcohol intervention in primary health care: findings of a World Health Organization collaborative study. J Stud Alcohol. 2005;66:379–388. doi: 10.15288/jsa.2005.66.379.
    1. Drevenhorn E, Bengtson A, Nilsson PM, Nyberg P, Kjellgren KI. Consultation training of nurses for cardiovascular prevention—a randomized study of 2 years duration. Blood Press. 2012;21:293–299. doi: 10.3109/08037051.2012.680734.
    1. Nilsen P, Aalto M, Bendtsen P, Seppa K. Effectiveness of strategies to implement brief alcohol intervention in primary healthcare. A systematic review. Scand J Prim Health Care. 2006;24:5–15. doi: 10.1080/02813430500475282.
    1. Keurhorst M, van Beurden I, Anderson P, Heinen M, Akkermans R, Wensing M, Laurant M. GPs' role security and therapeutic commitment in managing alcohol problems: a randomised controlled trial of a tailored improvement programme. BMC Fam Pract. 2014;15:70. doi: 10.1186/1471-2296-15-70.
    1. Anderson P, Bendtsen P, Spak F, Reynolds J, Drummond C, Segura L, Keurhorst MN, Palacio-Vieira J, Wojnar M, Parkinson K, et al. Improving the delivery of brief interventions for heavy drinking in primary health care: outcome results of the ODHIN five country cluster randomized factorial trial. Addiction. 2016. Epub ahead of print.
    1. Schulz KF, Altman DG, Moher D, Group C. CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials. BMC Med. 2010;8:18. doi: 10.1186/1741-7015-8-18.
    1. Keurhorst MN, Anderson P, Spak F, Bendtsen P, Segura L, Colom J, Reynolds J, Drummond C, Deluca P, van Steenkiste B, et al. Implementing training and support, financial reimbursement, and referral to an internet-based brief advice program to improve the early identification of hazardous and harmful alcohol consumption in primary care (ODHIN): study protocol for a cluster randomized factorial trial. Implement Sci. 2013;8:11. doi: 10.1186/1748-5908-8-11.
    1. Rubinsky AD, Dawson DA, Williams EC, Kivlahan DR, Bradley KA. AUDIT-C scores as a scaled marker of mean daily drinking, alcohol use disorder severity, and probability of alcohol dependence in a U.S. general population sample of drinkers. Alcohol Clin Exp Res. 2013;37:1380–1390. doi: 10.1111/acer.12092.
    1. Cartwright AJK. The attitudes of helping agents to the alcoholic client: the influence of experience, support, training and self-esteem. Br J Addict. 1980;77:413–431. doi: 10.1111/j.1360-0443.1980.tb01406.x.
    1. Cund A. Alcohol education revisited: exploring how much time we devote to alcohol education in the nursing curriculum. Nurse Educ Pract. 2013;13:35–39. doi: 10.1016/j.nepr.2012.07.005.
    1. Wilson GB, Lock CA, Heather N, Cassidy P, Christie MM, Kaner EF. Intervention against excessive alcohol consumption in primary health care: a survey of GPs’ attitudes and practices in England 10 years on. Alcohol Alcohol. 2011;46:570–577. doi: 10.1093/alcalc/agr067.
    1. Iqbal N, McCambridge O, Edgar L, Young C, Shorter GW. Health-care professionals’ attitudes across different hospital departments regarding alcohol-related presentations. Drug Alcohol Rev. 2015. doi:10.1111/dar.12243. [Epub ahead of print].
    1. Neville MW. Pharmacy students’ attitudes about treating patients with alcohol addiction after attending a required mutual support group. Am J Pharm Educ. 2014;78:39. doi: 10.5688/ajpe78239.
    1. Dinh P. Using multiple imputation to estimate cumulative distribution functions in longitudinal data analysis with data missing at random. Pharm Stat. 2013;12:260–267. doi: 10.1002/pst.1579.
    1. Scott A, Sivey P, Ait Ouakrim D, Willenberg L, Naccarella L, Furler J, Young D. The effect of financial incentives on the quality of health care provided by primary care physicians. Cochrane Database Syst Rev. 2011;CD008451.
    1. Roland M, Campbell S. Successes and failures of pay for performance in the United Kingdom. N Engl J Med. 2014;370:1944–1949. doi: 10.1056/NEJMhpr1316051.

Source: PubMed

Patrocinadores e Colaboradores

Condições médicas

Intervenções de drogas

3
Se inscrever